Angle of progression for predicting second-stage cesarean delivery complications

Objective: To investigate the correlation between the angle of progression (AOP) and maternal surgical complications following a second-stage cesarean delivery. Methods: We retrospectively evaluated singleton pregnancies at term (≥37 weeks) who underwent cesarean delivery for arrest of descent at the second stage of labor from January 2022 to December 2023. Only cases with recorded AOP were included. The fetal head position was confirmed by transabdominal ultrasound, and the fetal head station was assessed manually by digital examination. The main outcome was defined as a composite adverse maternal outcome, including challenging fetal extraction, uterine extension, requirement for blood transfusions, postpartum fever, ileus, and re-hospitalization due to endometritis or surgical site infection. Results: Twenty-five cases met the inclusion criteria, of whom 10 (40%) experienced the composite adverse maternal outcome. These patients had wider mean AOP compared to those without maternal morbidity (136.7 ± 7.4 vs. 124.7 ± 12.5, p =.017). Univariate logistic regression analysis showed a significant correlation between measured AOP and composite adverse maternal outcome (OR = 1.15, 95% CI 1.01–1.30, p =.028). The predicted probability for composite adverse maternal outcome by receiver-operating characteristics curve yielded an area under the curve of 0.79 (95% CI 0.60–0.98) for AOP, compared to an area under the curve of 0.53 (95% CI 0.30–0.75) for the manually measured fetal head station. Conclusions: We found a correlation between the angle of progression and maternal complications following second-stage cesarean delivery. Assessing the angle of progression before surgery may be of help to the obstetrical team to better identify susceptible cases and allow for appropriate preparation.